Common trust and personal safety issues: A systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness

Abstract

BackgroundPersons experiencing homelessness and vulnerable housing or those with lived experience of homelessness have worse health outcomes than individuals who are stably housed. Structural violence can dramatically affect their acceptance of interventions. We carried out a systematic review to understand the factors that influence the acceptability of social and health interventions among persons with lived experience of homelessness.MethodsWe searched through eight bibliographic databases and selected grey literature sources for articles that were published between 1994 and 2019. We selected primary studies that reported on the experiences of homeless populations interacting with practitioners and service providers working in permanent supportive housing, case management, interventions for substance use, income assistance, and women- and youth-specific interventions. Each study was independently assessed for its methodological quality. We used a framework analysis to identify key findings and used the GRADE-CERQual approach to assess confidence in the key findings.FindingsOur search identified 11,017 citations of which 35 primary studies met our inclusion criteria. Our synthesis highlighted that individuals were marginalized, dehumanized and excluded by their lived homelessness experience. As a result, trust and personal safety were highly valued within human interactions. Lived experience of homelessness influenced attitudes toward health and social service professionals and sometimes led to reluctance to accept interventions. Physical and structural violence intersected with low self-esteem, depression and homeless-related stigma. Positive self-identity facilitated links to long-term and integrated services, peer support, and patient-centred engagement.ConclusionsIndividuals with lived experience of homelessness face considerable marginalization, dehumanization and structural violence. Practitioners and social service providers should consider anti-oppressive approaches and provide, refer to, or advocate for health and structural interventions using the principles of trauma-informed care. Accepting and respecting others as they are, without judgment, may help practitioners navigate barriers to inclusiveness, equitability, and effectiveness for primary care that targets this marginalized population.

The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review

“…Alternatively, it is possible that lower intensity models work predominantly for homeless populations with less acute issues (or for those that are precariously housed), and this would suggest the importance of matching the intensity of the intervention with the acuity of need. Some indicators from a parallel qualitative review point to a case-manager-client relationship built on trust and continuity of care and integrated services as being key factors in the success of case management programs [99]. Many programs include peers and people with lived experience acting in case management roles [100][101][102][103], and while this has been identified as important to those confronted with homelessness [104][105][106], such approaches require formal evaluation.…”

Illness and drug modifiable factors associated with violent behavior in homeless people with severe mental illness: results from the French Housing First (FHF) program

“…While some intimate partner violence survivors require extensive and possibly long-term assistance to achieve safe and stable housing (especially if they are contending with multiple complex issues), others could avoid homelessness if provided with immediate, individualized, and flexible assistance (Sullivan et al, 2019). Practitioners and social service providers should also consider anti-oppressive approaches and provide, refer to, or advocate for health and structural interventions using the principles of trauma-informed care (Magwood et al, 2019).…”

Understanding Models of Support for People Facing Multiple Disadvantage: A Literature Review

“…Trauma may impact a person's capacity for coping, as well as their sense of safety, ability to self -regulate, their sense of self, perception of control and selfefficacy, and interpersonal relationships. Lived experience of homelessness and trauma has also been shown to lead to reluctance to accept interventions (Magwood et al, 2019). A comprehensive review of the evidence base on trauma-informed care 2 for people experiencing homelessness suggests that it is futile to attempt to solve the issue of homelessness (and its associated issues of offending, substance use and mental health) without addressing the underlying trauma that is so intricately interwoven with the experience of homelessness by practicing a trauma-informed approach (Hopper et al, 2009).…”